Toxicology

Alcohol intoxication at community festival

Foundation

Adult · 35yr · female

Patient Information

Dispatch	You are called to a patient (Sarah Nguyen, 35YO female) who is seated near the main stage at the Fremantle Community Festival. Bystanders report she has been drinking heavily and is confused and unsteady.
Patient	Sarah Nguyen — 35yr (65kg)
Incident History	Pt has been at the festival since midday. Friends report she consumed a significant amount of alcohol over approximately 4 hours. Pt is conscious but confused, unsteady on her feet, and slurring her words. No reported falls or trauma.
Emergency Contact	Melissa Nguyen (Sister) — 0412 334 781

Initial Rapid Assessment

Response	Voice
Airway	Patent. Nil airway obstruction. Nil stridor. Strong smell of alcohol on breath. Airway currently maintained.
Breathing	Breathing present and adequate. RR slightly slow. Nil wheeze or crackles auscultated.
Circulation	Radial pulse present, regular, adequate rate. Skin flushed and warm. Nil active bleeding.
Disability	GCS 12 (E3V4M5). Confused, not orientated to time or place. Orientated to person. Slurred speech. Pupils equal.
Exposure	Nil visible injuries. Nil rashes or urticaria. Clothing intact. No evidence of trauma.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	96% (RA)	Nil	13	92	108/70	<2s	12	4 4 ++	36.8	4.8 mmol/L	0
10 mins	97% (RA)	Nil	14	88	112/72	<2s	13	4 4 ++	36.8	4.8 mmol/L	0

History Taking

Treatment Response

Diagnosis

This patient is suffering from acute alcohol intoxication presenting with reduced GCS, slurred speech, confusion, and unsteady gait following excessive alcohol consumption at a community festival.

Facilitator Triggers — if trainees miss a critical step

! (If BGL is not assessed — patient's presentation deteriorates slightly and she becomes more drowsy; prompt trainee: 'You notice her eyes are getting heavier. What other assessment do you want to perform?')
! (If trainee does not place patient in lateral position when GCS drops or patient becomes drowsy — patient begins to vomit; prompt trainee: 'She suddenly vomits. What do you do now?')
! (If trainee does not reassess regularly — patient's GCS dips to 11 at 8 minutes; prompt trainee: 'Her friend says she seems sleepier than before.')
! (If trainee attempts to leave patient alone at any point — bystander advises 'she's trying to stand up and walk away.')

Treatment Objectives

1. Ensure scene safety — festival environment, assess for hazards, crowd control, bystanders.
2. Don appropriate PPE — gloves minimum, consider eye protection given vomiting risk.
3. Perform Primary Survey — confirm patent airway, adequate breathing, circulation, GCS 12.
4. Perform BGL assessment — confirm 4.8 mmol/L, rule out hypoglycaemia as contributing cause of altered GCS.
5. Position patient safely — seated upright initially; if GCS deteriorates further or patient becomes drowsy, place in lateral position to protect airway.
6. Apply pulse oximetry monitoring — confirm SpO2 96% on room air.
7. Perform full Vital Signs Survey — HR, BP, RR, SpO2, GCS, BGL, temperature.
8. Take IMISTAMBO-style history from patient and bystanders — confirm alcohol only, no other substances, no trauma, no medical history.
9. Do NOT administer oxygen unless SpO2 falls below 94% — patient is currently maintaining adequate saturations on room air.
10. Monitor patient closely — repeat observations every 10 minutes, document GCS trend.
11. Ensure patient is not left alone — continuous observation given reduced GCS and aspiration risk.
12. Do NOT allow patient to walk unassisted given unsteady gait and reduced conscious state.
13. Reassess airway continuously — particularly if GCS declines; prepare suction equipment.
14. Consider escalation — if GCS continues to decline, SpO2 drops, or patient cannot be roused, request ambulance backup via State Operations Centre.
15. Scenario ends on arrival of ambulance and IMISTAMBO handover.
16. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Unconsciousness · Disturbed & Abnormal Behaviour · Hypoglycaemia · Glasgow Coma Scale (GCS) · Blood Glucose Monitor · Lateral Position · Primary Survey · Pulse Oximetry

How did you go?

← Prev ← → navigate · Space reveal

Print Next →

Signs/Symptoms	Confusion, slurred speech, unsteady gait, flushed appearance.
Allergies	NKDA — no known drug allergies.
Medications	Oral contraceptive pill. No other regular medications.
Pertinent History	No known medical history. No history of diabetes or seizure disorder. Friends confirm no drug use other than alcohol. No head injury reported or witnessed fall.
Last Oral Intake	Last ate approximately 2 hours ago — festival food. Has consumed multiple alcoholic drinks since midday (friends estimate 6–8 standard drinks).
Events Leading	Patient was dancing and socialising near the main stage. Friends noticed she became increasingly unsteady and confused. They assisted her to a seated position near the barrier and called for first aid.
Treatment Prior	Nil treatment prior to EHS arrival. Friends gave her water to drink.

Onset	Gradual onset over approximately 4 hours of alcohol consumption since midday.
Pain	Nil pain reported.
Quality	Nil
Radiates	Nil
Severity	Nil pain. GCS 12 on arrival.